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5 Leukemia Nursing Care Plans

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By Matt Vera, BSN, R.N.
Leukemia Nursing Care Plans
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Leukemia is a malignant proliferation of white blood cell precursors in bone marrow or lymph tissue and their accumulation in peripheral blood, bone marrow, and body tissues. The blood’s cellular components originate primarily in the marrow of bones such as the sternum, iliac crest, and cranium. All blood cells begin as immature cells (blasts or stem cells) that differentiate and mature into RBCs, platelets, and various types of WBCs. In leukemia, many immature or ineffective WBCs crowd out the developing normal cells. As the normal cells are replaced by leukemic cells, anemia, neutropenia, and thrombocytopenia occur.

Nursing Care Plans

The care plan for patients with leukemia should be emphasized on comfort, minimize the adverse effects of chemotherapy, promote preservation of veins, manage complications, and provide teaching and psychological support.

Here are five (5) nursing care plans (NCP) and nursing diagnosis for patients with leukemia: 

  1. Risk for Infection
  2. Risk for Deficient Fluid Volume
  3. Acute Pain
  4. Activity Intolerance
  5. Deficient Knowledge
  6. Other Possible Nursing Care Plans

2. Risk for Deficient Fluid Volume

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Risk for Deficient Fluid Volume

Nursing Diagnosis

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Risk factors may include

  • Excessive losses, e.g., vomiting, hemorrhage, diarrhea
  • Decreased fluid intake, e.g., nausea, anorexia
  • Increased fluid need, e.g., hypermetabolic state, fever; predisposition for kidney stone formation/tumor lysis syndrome

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

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  • Demonstrate adequate fluid volume, as evidenced by stable vital signs; palpable pulses; urine output, specific gravity, and pH within normal limits.
  • Identify individual risk factors and appropriate interventions.
  • Initiate behaviors/lifestyle changes to prevent development of dehydration.
Nursing InterventionsRationale
Monitor I&O. Calculate insensible losses and fluid balance. Note decreased urine output in presence of adequate intake. Measure specific gravity and urine pH.Tumor lysis syndrome occurs when destroyed cancer cells release toxic levels of potassium, phosphorus, and uric acid. Elevated phosphorus and uric acid levels can cause crystal formation in the renal tubules, impairing filtration and leading to renal failure.
Weigh daily.Measure of adequacy of fluid replacement and kidney function. Continued intake greater than output may indicate renal insult or obstruction.
Promote good nutrition.Explain that chemotherapy may cause weight loss and anorexia so encourage the patient to eat and drink high-calorie, and high-protein foods. Note: Chemotherapy and adjunctive prednisone may cause weight gain, so dietary counseling and teachings are helpful.
Monitor BP and HR.Changes may reflect effects of hypovolemia (bleeding or dehydration).
Evaluate skin turgor, capillary refill, and general condition of mucous membranes.Indirect indicators of fluid status or hydration.
Note presence of nausea, fever.Affects intake, fluid needs, and route of replacement.
Encourage fluids of up to 3–4 L/day when oral intake is resumed.Promotes urine flow, prevents uric acid precipitation, and enhances clearance of antineoplastic drugs.
Inspect skin or mucous membranes for petechiae, ecchymotic areas; note bleeding gums, frank or occult blood in stools and urine; oozing from invasive-line sites.Suppression of bone marrow and platelet production places patient at risk for spontaneous or uncontrolled bleeding.
Implement measures to prevent tissue injury or bleeding, gentle brushing of teeth or gums with soft toothbrush, cotton swab, or sponge-tipped applicator; using electric razor and avoiding sharp razors when shaving; avoiding forceful nose blowing and needlesticks when possible; using sustained pressure (sandbags or pressure dressings) on oozing puncture and IV sites.Fragile tissues and altered clotting mechanisms increase the risk of hemorrhage following even minor trauma.
Provide adequate hydration, and a high-residue diet, stool softners, and mild laxatives. Encourage walking.To prevent constipation.
Limit oral care to mouthwash if indicated. Avoid mouthwashes with alcohol.When bleeding is present, even gentle brushing may cause more tissue damage. Alcohol has a drying effect and may be painful to irritated tissues.
Provide soft diet.May help reduce gum irritation.
Administer IV fluids as indicated.Maintains fluid and electrolyte balance in the absence of oral intake; prevents or minimizes tumor lysis syndrome, reduces risk of renal complications.
Administer medications as indicated: 
  • Antiemetics: 5-HT3 receptor antagonist drugs such as ondansetron (Zofran) or granisetron (Kytril)
Relieves nausea and/or vomiting associated with administration of chemotherapy agents.
  • Allopurinol (Zyloprim)
Improves renal excretion of toxic byproducts from breakdown of leukemia cells. Reduces the chances of nephropathy as a result of uric acid production.
May be used to alkalinize the urine, preventing or minimizing tumor lysis syndrome or kidney stones.
  • Stool softeners
Helpful in reducing straining at stool with trauma to rectal tissues.
  • Monitor laboratory studies: platelets, Hb/Hct, clotting
When the platelet count is less than 20,000/mm (because of proliferation of WBCs and/or bone marrow suppression secondary to antineoplastic drugs), patient is prone to spontaneous life-threatening bleeding. Decreasing Hb/Hct is indicative of bleeding (may be occult).
Administer RBCs, platelets, clotting factors.Can restore RBC count and oxygen-carrying capacity to correct anemia. Used to prevent or treat hemorrhage.
Maintain external central vascular access device (subclavian or tunneled catheter or implanted port).Eliminate peripheral venipuncture as source of bleeding.
Administer medications: oral contraceptivesMinimizes blood loss by stopping or slowing menstrual flow.
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2. Risk for Deficient Fluid Volume

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other care plans for hematologic and lymphatic system disorders:

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Matt Vera, BSN, R.N.
Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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